Unknown Knee Problem

[jckid]

I have had knee pain for 11 years now. I'm hoping that someone here might have a similar condition or may have heard of something that could help.

The pain is located below my kneecap, but to the left as I'm looking down (inside). The pain is not constant. It sometimes comes on while I'm running or cycling, but also comes on when I'm just doing day to day activities. The strange thing is that the pain is temporarily received by popping or cracking my knee (by bending the knee and then quickly straightening it--or sometimes just bending it while putting my body weight on it). I sometimes stop mid-ride to crack my knee, then continue on until the pain comes back, and then I do it again.

11 years ago a "loose body" showed up on an X-ray. They then did an MRI as a precoursor to surgery. The "loose body" did not show up on the MRI, so they decided that it was just a blip on the X-ray. They still wanted to do exploratory surgery, but I said no. Later another Dr. said it might be plica syndrome, but he never seemed quite sure. A sports med Dr. could not determine what it was either.

So here I am, all these years later. I recently had an X-ray on my knee, but they said that everything looked normal. I've learned to just live with it, but not a day goes by that I don't pop my knee at least several times--sometimes many times. I'm not going to give up the activities I love, so I figure I'll just have to do my best to block it out. The only thing is that I'm concerned that I may be doing damage that I may really pay for later.

Anyway, if you made it this far, thanks for taking the time to read this. If you have any thoughts or suggestions, please share.

[eddief]

I have had each knee scoped once. Each time was for cleaning up torn miniscus. Each time I was forced to get something done because when it "popped" on one knee I was unable to straighten my leg due to junk in the hinge...so to speak. On the other it was not quite as bad but still could not walk without a lot of pain.

I cycle more than any other physical ativity and so far these "clean ups" have been miracles of medicine as far as I am concerned.

Does not sound like this is your issue, but I don't think you can necessarily see messed up soft tissue in an xray.

[Jeff N.]

Sounds like arthritis to me. MRI'll givya answers. Jeff N.

[Tony Prioli]

Are your quad muscles strong? My local Knee doctor, wants all athletes over 40, to add more conditioning to the quad muscles. He claims a week quad, will let the knee cap drop below the center of the knee joint, and the pain can be scraping the knee cap about where you are saying. This has helped many of my customers in the past. I have been fortunate to not have knee pain, and also I am in my 30's.

Good Luck, and keep trying things.

[Ginger]

Ditto on the quad strength, paying particular attention to the V2.
Have your doc send you to a Physical therapist to "evaluate and treat." There are many exercises that can help you strengthen the correct muscles to help everything in the knee track correctly. It could be that one of the muscles is pulling the kneecap over and causing a stress type pain on some tendon or another...just a thought...

I had a plica condition and was told that I had condromalacia for years. My plica pain was time related, if I rode less than 20 minutes, or more than three hours my knee hurt. Nothing "fixed" the plica issue other than surgery.

When they did the scope on my right knee to clear capsule lining that had been ripped up in my mortocycle accident, they also trimmed up the plica issue and found that my kneecap was pristine...no chondromalacia after all. Most of the problem had been quad muscle imbalances that caused soft tissue issues and pain. A physical therapist can help you out in that arena.

[mwos]

I too was diagnosed with chrondomalicia many years ago. The first ortho told me I should quit exercising! I got orthothodics but the pain didn't go away. After fooling with it myself for a few years I saw a ortho that put me in touch with a really good physical therapist who helped me understand and deal with the problem. I also worked with a rehab trainer at my local gym who focused on strengthening the quads, proper weight lifting techniques and stretching. I can't say I'm totally pain free but when I have a flair up I know how to address the problem.

This week I had my knee x-rayed due to my ski accident. One of the x-rays was in a standing position with my knees slightly bent. I don't remember my knees being x-rayed like that before. However, the pictures showed damage to my knees due to the chrondomalicia.

Running is very hard on my knees as is any kind of deep knee bending or doing a new activity without preparation. For example, at the beginning of the cycling season I concentrate on short base miles before I do any long distance rides or many hills. I did four bike tours in the summer of 04 with little pain or problems.

Also, do you have the correct length crankarms on your bicycle? Mine are 165's but I was thinking of going to 170's when I build my new bike. The ortho vetoed that idea saying that my knee would be put in a deeper bend at the top of the stroke which would damage my knees more and Speedplay pedals are, in his opinion, the best pedals for knee problems

The second ortho I saw for my knee problems way back when warned me not to ignore the pain and take very good care of my knees with strengthening and stretching exercises as I would end up with worse problems as I got older.

Good luck,

Kathi

[Kane]

Healing is on the way ... maybe. You likely have a meniscus with wear and tear. There maybe other complications. I have rehabbed a lot of knees. It is a bit of a challenge to do it long distance. Here are some of the issues to work on.

Supplements:
-Fish oils: 1500 - 3,000 mg, avoid anti-inflammatory medication. This medication causes over 27,000 deaths per year in the U.S. alone from GI bleeding. They weaken the tissue around the knee.
-Glucosamine Sulfate 1500 mg

Pronation - orthotics from a good podiatrist or go to wellfeet.com. I have seen Dr. Doug Ehrenberg work on Lance at our former office in S.F. He is that good!!

"Knee Pain:
Knee pain can be from many causes, including trauma and arthritis, but in some cases it can be due to abnormal biomechanics. Anterior knee pain (front of the knee at the knee cap) is often caused by tracking dysfunction of the patella, or knee cap, in its groove on the femur. This abnormal tracking may cause softening of the cartilage on the under-surface of the knee cap where it contacts the thigh bone or femur. This condition is called chondromalacia patella, and it often affects athletes, particularly runners and bicyclists. It is referred to by some as "runners knee". In the early stages of the condition, softening of the cartilage results, but breakdown of the cartilage has yet to occur. If untreated, permanent damage to the cartilage may occur, which involves erosion of the cartilage.

If you think you suffer from chondromalacia patella, the first thing to do stop the activity that caused the pain. Next, inspect your shoe gear and make sure the midsoles and heel counters on your shoes are not broken down. Broken heel counters and compressed midsoles will allow your feet to roll inward and pronate excessively. This motion imparts an internal rotation and inward angling of the leg which effects how the patella tracks on the femur. Once the pain has resolved, the next step is to strengthen your quadriceps muscles, especially the vastus medalis oblique. This is the muscle on the inside of your knee above the knee cap. Straight leg raises and extension exercises that focus on the last 15 degrees of extension are helpful. Leg press machines are good for this. Avoid leg extension machines where you start with your knee flexed at 90 degrees. A physical therapist or certified athletic trainer can show you what is safe. If you have done all the above and you have new shoes, yet you continue to have pain and you over-pronate, orthotics may help." Doug Erenberg DPM.

Doug is talking about Patellar tendonitis, but a meniscal irritation is aggravated by the same rotation of the tibia.

TIGHT MUSCLES need to be stretched (see a pt or dc):
Quad muscle: rectus femoris
Calf muscle: gastro and soleus
Hamstring muscles.

WEAK MUSCLES:
Strengthen the above muscles.

SUPERFICIAL FASCIA: Your skin is glued up to the bone over the medial meniscus and around your knee from chronic inflammation. Grab a hunk of skin around your knee and bend your knee ... ouch! It hurts, but it can and will improve. This is called skin rolling and it is mandatory for the best result. I know three secret stretches for fascia that are too difficult to describe, but they cured my 30 year knee pain. If you are near S.F. come see me as a patient and I can teach you these very powerful exercises.

Cheers,


Kane